Immunizatuon Chiss

IMMUNIZATIO
N
A vaccine consists of killed or live attenuated organisms or specific
antigens of a pathogen, which when administered to previously
unexposed individuals, will elicit an immune response but not cause the
disease.
Active immunity is the protective response mounted by the immune
system following exposure to an infectious organism ( as clinical or
subclinical infection) or after vaccination with live or killed organism, a
toxoid or subunit.
Comprises humoral and cellular immune responses.
First exposure the primary immune response – slow (3-14 days)
and insufficient .
The humoral response- formation of IgM followed by IgG antibodies.
Re-exposure to the infectious agent – secondary response – rapid, long
lasting and induces high titers of high affinity IgG antibodies – sufficient
protection .
Passive immunity refers to protection from disease provided by
introduction of preformed animal or human antibodies into the body.
Immunization is the process of inducing acquired immunity, by
administering
i. Vaccine prior to natural exposure to infectious agent (active
immunisation)
ii. Preformed exogenous antibodies soon after exposure to suppress the
disease (passive immunization)
Vaccination is the process of administration of a vaccine.

Seroconversion refers to the change from antibody negative to
antibody positive state, due to induction of antibodies in response to
infection or vaccination.
Seroprotection refers to the state of protection from disease, due to
the presence of detectable serum levels of antibody.
Immunogenicity is the ability of a vaccine to elicit an immune
response, whether cellular, humoral or both.
Adjuvants are substances unrelated to the organism that, when added
to a vaccine, enhance its immunogenicity. Eg. Aluminium hydroxide and
lipids.
Protective efficacy is the vaccine's actual ability to protect against
disease.
Efficacy = rate of disease in unvaccinated- rate in vaccinated x 100
rate of disease in unvaccinated persons
Live viral vaccines and toxoids – more efficacious than BCG and killed
bacterial vaccines.
Vaccine effectiveness is the ability of a vaccine to protect the
population from disease, when administered in an immunization
program.
Depends on herd immunity, vaccine efficacy and program
implementation.
Vaccine failure is the occurrence of disease in an individual despite
vaccination. It is rare.
 Primary vaccine failure is the inability of the recommended vaccine
dose(s) to induce an immune response (OPV)
Secondary vaccine failure refers to the occurrence of disease despite
an immune response (BCG, pertussis, typhoid vaccines)
Herd effect - If a large proportion of susceptible individuals are protected from
infection with an organism by simultaneous vaccination, the transmission chain
of the infectious agent can be broken by reducing carriage of the causative
microorganism by vaccinated individuals, thus decreasing the risk of disease
even among the unimmunized individuals.
Herd immunity: refers to the proportion of immune individuals in a population.
Herd immunity threshold: minimum proportion of population that must be
immunized to eliminate disease.
Less marked for –
Vaccines that protect only against disease (diphtheria) than those which
prevent infection (measles or OPV)
◦ Vaccines with low protective efficacy (pertussis,typhoid)
◦ Vaccines against diseases where humans are not the chief reservoir (tetanus)
Types of vaccines
Live vaccines replicate in the host to produce an immune response
mimicking natural infection- infect the recipient but do not cause
disease.
Storage and transportation conditions are critical to maintain the
potency.
Killed vaccines prepared by growing bacteria or viruses in media
followed by heat or chemical (e.g. formalin) inactivation, do not cause
infection but elicit protective immune response.
Multiple doses required (cant replicate)
Booster doses are necessary for prolonged protection.
Most of them – local and systemic reactions.
Toxoids are modified and purified toxins that are not injurious to the
recipient.
Given as multiple divided doses - to decrease the adverse effects & to
elicit high antibody titres.
Booster doses required.
Subunit vaccines –
◦ capsular polysaccharide
◦ viral or bacterial subunits.
Capsular polysaccharides are carbohydrate antigens that elicit humoral

response by stimulating B cells directly, without modulation by helper T
cells.
No immunological memory and only IgM antibodies are produced.
PRINCIPLES OF IMMUNISATION
Vaccines available as lyophilized powder are reconstituted in:
•Sterile or distilled water (measles, mumps, rubella, rabies)
•Normal saline (Hib)
•Another vaccine (combined vaccination with separately available DTaP,
IPV and Hib vaccines)
Maximum time b/w reconstitution and use – 30 minutes ( MMRV,
DTaP- IPV- Hib) , 8 hours (MMR) or 24 hours (Hib, rota)
BCG VACCINE
Contains bacilli derived from subcultures of live attenuated M. bovis
Primarily induces cell mediated immunity
Enables protection against severe forms of TB and reduces risk of
mortality
POLIOMYELITIS VACCINES
OPV
Contains live vaccine (Sabin polioviruses) attenuated by repeated
passage in monkey kidney cell cultures and stabilized with magnesium
chloride.
Infects intestinal mucosa and multipies there- interrupting wild virus
circulation and reducing feco oral transmission.
To decrease chances of failure- atleast 3 doses 4-8 weeks apart. Zeroth
dose enhances seroconversion.
Vaccine associated paralytic poliomyelitis (VAPP) in 1 of 1.5 million OPV
recipients.( OPV 3 or OPV 2)
IPV
Suspension of formaldehyde killed (salk) poliovirus grown in monkey
kidney, human diploid or Vero cell culture.
Induces humoral immune response.
High seroconversion rates
Doesn’t cause VAPP
DIPHTHERIA, PERTUSIS
AND TETANUS VACCINES
Diphtheria vaccine contains diphtheria toxin (DT) inactivated by
formalin and adsorbed on aluminium hydroxide.
DTwP causes local (pain and redness) and systemic (fever)- attributed to
the pertussis component- this led to development of purified acellular
vaccine DTaP.
Vaccine shouldn’t be used beyond 5 doses or 7 years of age.
Contraindicated people should take DT vaccine. After 7 years of age Td
must be used.
TETANUS VACCINE
Immunizing pregnant women with 2 doses with 2nd dose administered 4
weeks prior to delivery provides passive immunity to the baby due to
transplacental passage of IgG antibodies.
Formalin inactivated and adsorbed on aluminium salts.
• Each dose of TT vaccine contains 5 Lf of the toxoid.
• The vaccine is heat stable and remains potent for a few weeks even at
37°C.
•The efficacy of TT vaccine varies between 80-100%.
MEASLES CONTAINING
VACCINES
Derived from Edmonston Zagreb strain
Available as monovalent preparation, or in combination with rubella(MR),
mumps (MMR) and varicella (MMR-V)
Cellular and humoral immune responses are elicited
HEPATITIS B VACCINE
Contains surface antigen HBsAg, produced by recombinant DNA
technology in yeast, adsorbed in aluminium salt as adjuvant
Prevents horizontal transmission
Mother HBsAg positive- receive vaccine within few hours of birth along
with HBIG within first 24 houra at seperate sites
HEMOPHILUS VACCINE
Hib- causes pneumonia, meningitis and bacteremia
Contains Hib polysaccharide, polyribosylribitol phosphate (PRP) which is
conjugated to tetanus toxoid, mutant diphtheria toxin or meningococcal
outer membrane protein.
PNEUMOCOCCAL
VACCINE
Pneumococcal pneumonia- leading cause of vaccine preventable
deaths
Two kinds available:
1. Unconjugated polysaccharide vaccine- 25microgram capsular
polysaccharide of each of the 23 serotypes
2. Conjugate vaccine- polysaccharide of 13 most commonly pathogenic
serotypes linked to a diphtheria carrier protein (PCV13) and a 10
valent conjugate vaccine (PCV 10) combined with H. Influenzae
vaccine
ROTAVIRUS VACCINE
Chief cause of diarrhea in infants and toddlers.
JAPANESE B
ENCEPHALITIS
VACCINE
Combination vaccines
A combination vaccine consists of multiple immunogens physically
combined in a single preparation, including antigens or serotypes of the
same pathogen (e.g. trivalent polio vaccine) or different pathogens (e.g.
DTP vaccine).
Benefits – number of injections at each visit is decreased, fewer visits
are required - increased compliance and enhanced immunization
coverage.
Challenges –
The antigens combined together in a vaccine should be compatible with each
other
Should not interfere with each other's immunological 'take' (relevant especially
for live viral vaccines)
Should be indicated at the same time.
Some antigens may require an adjuvant to be present in the combination
The total volume of the vaccine should not be excessive .
The product should be stable for at least 18-24 months.
Combination vaccines in common use include DTwP, DTaP, DT, dT, OPV, IPV,
MMR and influence vaccines
ADVERSE EVENTS FOLLOWING IMMUNISATION
Vaccine-specific events include:
i. Oral polio: Paralytic polio or vaccine strain polio within 1-6 months of
vaccine administration
ii. Measles: Thrombocytopenic purpura within 7-30 days; measles infection
in an immunodeficient recipient ≤6 months
iii. Measles, mumps and/or rubella: Encephalopathy or encephalitis <15
days
iv. Tetanus: Brachial neuritis 28 days
v. Pertussis: Encephalopathy or encephalitis ≤7 days
vi. Rotavirus: Intussusception ≤30 days; and vii. Rubella: Chronic arthritis <6
weeks.
Other serious vaccine specific events include:
1. DTP Hypotensive hyporesponsive epidose

2. DTP: Inconsolable cry
3. Measles (S. Aureus contamination): Toxic shock syndrome
4. BCG: Axillary lymphadenitis. There is no causal relationship between
MMR vaccine and autism or inflammatory bowel disease.
COLD CHAIN
Cold chain is the system of transporting, storing and distributing vaccine
in a potent state at recommended temperature till it is administered to
an individual. It is the vital link between the child and immunity in
immunisation against vaccine preventable diseases (VPD).
Vaccines such as OPV, measles and BCG (especially after reconstitution)
are sensitive to heat but may be frozen without harm
In contrast, vaccines like hepatitis B, DTP, penatavalent vaccine and
tetanus toxoid are less sensitive to heat and are damaged by freezing.
Certain vaccines lose their potency if exposed to bright light, and are,
therefore, packaged in dark brown glass (BCG, MMR, measles and
rubella vaccine).
Within the refrigerator, OPV vials are stored in the freezer compartment
(0 to -4°C). BCG, measles and MMR vaccines are kept in the top racks of
the main compartment (4-10°C) (just below the freezer); DTP, DT, TT,
hepatitis A and typhoid are stored in the middle racks; and hepatitis B,
varicella and diluents are stored in the lower racks.
VACCINE VIAL
MONITORING
Before opening a vial,check the status of vvm
There are four different types of VVMs for different vaccines depending
on their heat stability.
VVM 30: High Stability, used on the least heat sensitive vaccines.
VVM 14: Medium Stability.
VVM 7: Moderate Stability.
VVM 2: Least Stable, used on the most heat sensitive vaccines.
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Immunizatuon Chiss

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IMMUNIZATIO

Vaccination is the process of administration of a vaccine.

Capsular polysaccharides are carbohydrate antigens that elicit humoral

1. DTP Hypotensive hyporesponsive epidose

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